Emergency Thoracotomy

A resuscitative thoracotomy (sometimes referred to as an emergency department thoracotomy (EDT), trauma thoracotomy or, colloquially, as "cracking the chest") is a thoracotomy performed to resuscitate a major trauma patient who has sustained severe thoracic or abdominal trauma and who has entered cardiac arrest because of this.[1] The procedure allows immediate direct access to the thoracic cavity, permitting rescuers to control hemorrhage, relieve cardiac tamponade, repair or control major injuries to the heart, lungs or thoracic vasculature, and perform direct cardiac massage or defibrillation. For most persons with thoracic trauma the procedure is not necessary; only 15% of those with thoracic injury require the procedure
A resuscitative thoracotomy is indicated when severe injuries within the thoracic cavity (such as hemorrhage) prevent the physiologic functions needed to sustain life. The injury may also affect a specific organ such as the heart, which can develop an air embolism or a cardiac tamponade (which prevents the heart from beating properly). Other indications for the use of this procedure would be the appearance of blood from a thoracostomy tube placed that returns more than 1000-1500 mL of blood, or ≥200 mL of blood per hour.[citation needed]

For resuscitative thoracotomy to be indicated, signs of life must also be present, including cardiac electrical activity and a systolic blood pressure >70 mm Hg.[2][3] In blunt trauma, if signs of life, such as eye dilatation, are found en route to the hospital by first responders, but not found when the patient arrives, then further resuscitative interventions are contraindicated; however; when first responders find signs of life and cardiopulmonary resuscitation time is under 15 minutes, the procedure is indicated.[4]

The use of a focused assessment with sonography for trauma may be performed to determine the need of the procedure by finding free floating fluid in the thoracic cavity.[

1. By Capt Shams Emergency Thoracotomy

2. Emergency Thoracotomy Introduction Types Indications Contraindications Approaches Complications Conclusion

3. Emergency Thoracotomy is an open surgical technique carried out as an intervention for life threatening chest injuries. Introduction

4. Emergency department thoracotomy or sternotomy: Performed immediately At the emergency department Planned emergency thoracotomy: Following diagnosis of a specific injury At the operation theatre Types

5. Indication Pericardial tamponade Control of haemorrhage from intra thoracic injury Initial haemorrhage > 1500 ml through chest tube Ongoing haemorrhage > 200 ml/h over 3-4 hours Systolic BP < 70 mmHg despite resuscitation Control of massive air leak Clamping of the thoracic aorta Open cardiac massage Control of air embolism

6. Indication Pericardial tamponade Control of haemorrhage from intra thoracic injury Initial haemorrhage > 1500 ml through chest tube Ongoing haemorrhage > 200 ml/h over 3-4 hours Systolic BP < 70 mmHg despite resuscitation Control of massive air leak Clamping of the thoracic aorta Open cardiac massage Control of air embolism

7. Contraindication CPR in absence of intubation > 5 minutes CPR despite intubation > 10 minutes Blunt trauma with no sign of life

8. Approaches Left anterolateral thoracotomy Right anterolateral thoracotomy Clamshell incision Median sternotomy

9. Complications Injury to the surrounding structures Left phrenic nerve, coronal vessels, etc. Bleeding Infection Complications related to chest drain

10. A chest drain is kept in situ following the surgery and is monitored regularly to assess the post operative recovery. Emergency thoracic surgery is an essential part of the skill of any surgeon dealing with major trauma. Conclusion

11. Thank You